Superior vena cava thrombosis after in vitro fertilization: Case report and review of the literature

Ovarian hyperstimulation syndrome (OHSS) is a rare complication of fertilit y medication. A 33 year old female with OHSS with thrombosis of the right i nternal jugular vein, subclavian vein, and superior vein cava underwent in vitro fertilization following stimulation with a GnRH analog with successfu l implantation. The patient developed abdominal distention and dyspnea, wit h persistent symptoms that resulted in a 20 lb weight loss. As pregnancy pr ogressed, edema, pain, and tingling sensations developed by the ninth week at which time a Ci scan confirmed thrombus with the right internal jugular and subclavian vein and a free floating tip in the superior vena cava. Foll owing treatment with intravenous heparin therapy and subcutaneous low-molec ular weight heparin until delivery her symptoms improved. While optimal tre atment remains unclear, treatment strategies remain conservative. Identifyi ng the risk factors that lead to the development of OHSS including the iden tification of those patients at risk for developing OHSS, more extensive in vestigation of potential underlying coagulopathy in severe or recurrent cas es, and consideration of prophylactic subcutaneous heparin or IV albumin su pplementation, will facilitate prevention in the high risk population. DOI: 10.1007/s100169910049.